The Poor Diabetic

The poor diabetic may have problem managing diabetes because of inability to afford supply or necessary diabetes education. There are many risk factors for diabetes which have been discovered earlier. The most important ones are obesity, sedentary lifestyle, genetics. But lately, there are new studies which discovered a strong link between the poverty and diabetes. Diabetes has a higher incidence in poor population than in the more rich population. Poverty is also linked to poor diabetes control, higher incidence of complications. Poor men have a twice higher risk of getting diabetes than rich men. The situation in women is even more severe. Poor woman has three times higher chance of getting diabetes than a rich woman.

Good management of diabetes can prevent symptoms and signs of diabetes from occurring. In the case of poor diabetes control, glucose levels are too high and hard to control.

Causes of poor management in poor diabetic population

The main cause of poor diabetes management in poor population is the lack of money. Poor people will not be able to purchase all the needed medicines. They will not be able to be on a strict diet which is mandatory for diabetes patients. Poverty is a big concern and often a cause of stress, which plays a great role in diabetes.

Diabetes Symptoms and the Poor Diabetic

Poor patients in most cases won't have well-regulated glucose levels. They will have most of the diabetes symptoms like frequent thirst, frequent urination, fatigue, feeling hungry more often. Poor diabetes patients will also have a lot of complications which can often lead to death in this category of patients.

Diabetes Complications in the Poor Diabetic

The risk of complications is high in poor people which often have poor diabetes control. They have a high risk of vascular complications such as ulcers and gangrene of distal parts. At highest risk is feet. If poor diabetes control leads to gangrene it will end up in the amputation of a limb. Poor diabetes can even cause heart diseases such as heart attack. Blood vessels in the brain will also be affected. If poor diabetes control remains for a longer period of time it may lead to stroke.

It will also damage vision and cause diabetic retinopathy. Vision can be damaged by lens degeneration which is a lot faster in patients with poor diabetes control. Another way on which high blood sugar can damage vision is by damaging blood vessels in human eyes.  It will lead to macular degeneration.

Kidneys are another organs which are damaged by poor diabetes control. It will damage glomeruli, which are the main functioning unit of kidneys. If a kidney is well damaged then it will cause chronic renal failure. That will lead to an increase of uremic acid and creatinine in the blood. Some of the patients will need hemodialysis.

High blood sugar levels for a longer period of time will cause nerve damage. It will lead to neuropathy. 

Diagnosis

Another problem in poor diabetes patients is delayed diagnosis. In most cases, they will seek medical attention later than richer patients. They often do not recognize symptoms until complications are developed.

There are two main methods to determine the effects of diabetes therapy : measurement of A1c level and measurement of serum glucose levels.

The best way to control if diabetes management is giving good results is a controlling level of A1c. It will show the average serum glucose level for a period of the last three months. It would be ideal if it could be under 7.5. In case A1c level is above 9.0 then we can talk about poor diabetes control. Some research shows that controlling A1c levels more often can lead to better management of diabetes and prevention of poor diabetes. Poor patients will not be able to test A1c level if they do not have insurance. That can be a big problem in poor communities.

You can also measure current levels of blood glucose. It can be done at home using a glucometer. Random blood sugar level or RBS can be measured at any time of day. Another method of measurement is fasting blood sugar or FBS. It will measure the level of serum glucose after at least 8 hours of fasting. This can be a problem for poor diabetic patients because most of them can't afford glucometer.

In patients with poor diabetes control, all these tests will show elevated levels of blood sugar. Another problem with poor diabetic patients is a lack of commitment to regular check-ups. Most of them will avoid regular check-ups.

Therapy

The most important steps in diabetes therapy are a change of diet, increase in activity and medicines. Poor diabetic patients in most cases do not follow given instructions.

First two steps are the same for both types of diabetes. You should avoid food rich in calories, fat, carbohydrates. Start working out daily. You can start walking, swimming or jogging. 25 to 30 minutes of exercise daily would be enough. Poor patients will probably have a financial problem when it comes to the type of food which is recommended for them. They will stick to fast food and other types of unhealthy food.

Persons with type 1 diabetes should be treated with insulin. In most cases, insulin should be given via injection or insulin pump several times per day. Poor patients often can not afford to take insulin regularly or in some cases, they are not well educated to take the insulin by themselves.

For obese individuals which have poor diabetes control, bariatric surgery is one of the solutions combined with medicines and lifestyle changes. Poor diabetic patients will probably have no insurance so this therapy method is out of their range.

Preventing Diabetes Among the Poor

The main goal in prevention of diabetes in poor people should be obtaining adequate health care for them. Poor diabetic patients should have an opportunity to seek for medical advice in early stage of disease. More effort should be given to educate this category of patients.

They should know the advantages of well controlled diabetes and the risk they are taking by not regulating their blood sugar levels.

The a1c level should be used to adjust therapy methods. It should be controlled regularly because if it is not controlled there is a chance that it might cause poor diabetes control. Patients should be educated on the importance of proper control of diabetes and importance of regular control of A1c level.

References:

Bronstein, R.M., "Diabetes and Poverty“, 2015, retrieved from http://www.diabeticlifestyle.com/everyday-life/diabetes-poverty

Diabetes in control, "Poverty a Leading Cause of Type 2 Diabetes“ , 2010, „diabetesincontrol.com“, retrieved from http://www.diabetesincontrol.com/poverty-a-leading-cause-of-type-2-diabetes-studies-say/

Diabetes UK, "Diabetes Complications“, retrieved from https://www.diabetes.co.uk/diabetes-complications/diabetes-complications.html

HRSA, "Diabetes HbA1c {Poor Control}“, retrieved from http://www.hrsa.gov/quality/toolbox/measures/diabetes/

Hsu C.C., Lee, C.H., Wahlqvist, M.L., Huang, H.L., Chang, H.Y., et al., "Poverty increases type 2 diabetes incidence and inequality of care despite universal health coverage.“, 2012, Diabetes Care. 35(11):2286-92. doi: 10.2337/dc11-2052.

Mitchell B. Feldman, "Poor diabetes management has severe risks“, 2011, retrieved from http://auburnpub.com/lifestyles/poor-diabetes-management-has-severe-risks/article_1eb3a10e-492b-11e0-9b6d-001cc4c002e0.html

The National Institute of Diabetes and Digestive and Kidney Diseases, "Principle 6: Control Blood Glucose to Prevent or Delay Diabetes“, retrieved from https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/guiding-principles/principle-06-control-blood-glucose/Pages/principle-06-control-blood-glucose.aspx#category=blood-glucose-management,1,3,4


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